TCM beauty · Concern
Dark circles under the eyes
黑眼圈
How TCM reads it
In Chinese medicine, dark circles under the eyes (黑眼圈, hēi yǎn quān) are read as a sign that the tissue around the eye is not being properly nourished, or is holding Blood that has stopped moving. The colour alone says little. What a practitioner asks about is when the darkness began, whether it is worse on waking or at the end of the day, and what accompanies it.
Two anatomical ideas explain why the eye area shows things early. The Bladder channel (足太阳膀胱经) begins at the inner corner of the eye and runs over the head, and the Stomach channel runs up through the face to the eye region. Both are treated as long channels with a lot of territory, and a stagnation or a deficiency anywhere along them can be read at the point where the skin is thinnest.
The third idea is that the eye is the place where the quality of Blood and of Kidney essence shows most plainly. Liver Blood is said to nourish the eyes, and Kidney essence is said to be the deepest reserve the body draws on. Dark circles that come with fatigue, poor sleep and dry eyes are therefore read as a depletion picture, while dark circles that are fixed and dusky are read as stagnation.
The four patterns below point to different treatments, and one person can carry more than one.
The patterns at a glance
| Pattern | What it looks like | Other signs | Tongue | Common approach |
|---|---|---|---|---|
| Kidney and Liver Yin Deficiency | Dull, dark and dry, lacking lustre, worse with tiredness | Dry eyes, low back ache, night sweats, scanty dark urine, a feeling of heat in the palms and soles | Red, with little coating | Nourish Yin: Qi Ju Di Huang Wan, Zuo Gui Wan, Er Zhi Wan |
| Blood Stagnation | Fixed, dark, purplish or bluish, not shifted by sleep or rest | Fixed pain, dark lips, a choppy pulse, long-standing dull skin | Dusky or purple | Move Blood: Tao Hong Si Wu Tang |
| Spleen and Stomach Qi Deficiency | Pale, slightly puffy, tired-looking, with a sallow tone | Fatigue, poor appetite, loose stools, bruising easily | Pale and tooth-marked | Tonify the Spleen: Gui Pi Tang |
| Kidney Yang Deficiency with Water overflowing | Puffy and dark, worst on waking, settling through the day | Cold limbs, swelling of the ankles, frequent clear urine | Pale and wet | Warm Yang and move water: Zhen Wu Tang |
Each pattern explained
Kidney and Liver Yin Deficiency
This is the pattern most often described for the eye area, and the one most often confused with a simple lack of sleep. The darkness is dull rather than fixed, the skin around the eye looks thin and dry, and there is usually a longer story: fatigue that comes on easily, a dry mouth at night, low back ache, night sweats, and sometimes a feeling of heat in the palms, soles and chest. The tongue tends to be red with little coating.
The reasoning is that Liver Blood and Kidney essence are the substances the eye draws on, so treatment nourishes them rather than working on the skin. The formulas used are the Yin-nourishing ones: Qi Ju Di Huang Wan for the eye focus, Zuo Gui Wan and Er Zhi Wan for the deeper reserve. Herbs that recur are Gou Qi Zi and Nu Zhen Zi, both traditional for the eyes and the Liver and Kidney.
Blood Stagnation
Here the darkness is fixed. It does not shift after a good night, it may be purplish or bluish at the inner corner, and the skin may look thick or dusky rather than thin. The pattern is read when there has been a long-standing problem, a history of poor circulation, a fixed pain elsewhere, or a dusky tongue.
The treatment principle is to move Blood and break the stasis. Tao Hong Si Wu Tang is the classical formula, and Dang Gui and San Qi are the herbs most associated with the eye area in this reading. San Qi carries a bleeding caution and is avoided in pregnancy, and none of the Blood-moving herbs should be taken by anyone on anticoagulant medication without advice.
Chengqi (ST-1) sits on the bony rim directly below the eye, and in acupressure it is held only with light pressure on that rim, never on the eyeball.
Spleen and Stomach Qi Deficiency
The face here looks tired and slightly puffy, pale rather than dark, with a sallow undertone around the eye. It comes with the ordinary signs of a weak middle: poor appetite, loose stools, fatigue after eating, and bruising more easily than before. The tongue is pale and often tooth-marked.
The reasoning is that the Spleen makes the Blood and moves the fluids, so when it is weak the face is undernourished and slightly waterlogged at the same time. Treatment strengthens the Spleen and nourishes Blood: Gui Pi Tang is the usual choice, with Bai Zhu and Fu Ling for the Spleen and Dang Gui for the Blood.
Kidney Yang Deficiency with Water overflowing
This is the puffy, dark picture, worst on waking and settling as the day goes on. It comes with cold limbs, swelling in the ankles, frequent clear urine and a pale, wet tongue. The darkness is secondary to the fluid; the face is carrying water it has not moved.
The treatment warms Yang and moves the water, and Zhen Wu Tang is the classical formula for the pattern. This is the pattern that most deserves a medical check, because fluid retention has causes outside Chinese medicine, and the eye area is not the place to treat it by yourself.
Self-care by pattern
For the depletion picture the useful habits are unglamorous: a regular sleep time, less late work, and food that supports Blood and Yin rather than more stimulants. eating-for-skin sets out the framework, and sleep-stress-skin covers the sleep side in detail. Gentle facial acupressure around the orbital bone, described on facial-acupressure, is the practice most often used alongside.
For the stagnation picture the self-care is movement: walking, gentle facial gua sha on calm skin, and any practice that interrupts a sedentary day. gua-sha-face sets out the routine, and the warning stands that it is not done over inflamed skin.
For the Spleen picture the emphasis is on warm, cooked, regular meals and not skipping breakfast, again with the framework rather than a menu on eating-for-skin.
For the fluid picture the first step is not a herb. It is a doctor, because ankle swelling and facial puffiness have causes that need excluding, and one of them is kidney or heart disease. Once that is done, the self-care is salt, sleep position and movement.
Two simple things apply to every pattern: sleeping with the head slightly raised reduces overnight fluid settling around the eyes, and sun protection matters around the eye because the skin there is thin.
Points that are safe to press gently in self-care are Cuanzhu (BL-2) at the inner end of the eyebrow, Yintang (GV24+) between the eyebrows, Sibai (ST-2) on the cheekbone below the eye, and Chengqi (ST-1) on the bony rim directly below the eye. All four are pressed with the pad of a finger, lightly, never deep, and never on the eyeball itself; Chengqi takes only the lightest pressure on the rim, never pressure into the socket. Sanyinjiao (SP-6) is classically avoided in pregnancy and should not be pressed by anyone who is pregnant. Jingming (BL-1), at the inner corner of the eye, is excluded from every self-care step.
The conventional view
Dermatology reads dark circles, or periorbital hyperpigmentation, as a multifactorial appearance with four broad contributors: pigment in the skin, visible blood vessels under thin skin, the shadow cast by changes in the shape and volume of the tissue around the eye, and the effects of lifestyle and other conditions.
The pigmentary component is the one this compendium already covers on its own pages. Skin pigmentation and Melasma deal with pigmentation as a clinical subject, and this page does not restate them.
The vascular component is often what makes circles look blue or purple, and it is more visible where the skin is thin. The structural component is about volume and shadow rather than colour at all, which is why some circles look worse in certain lighting. Allergy, nasal congestion, poor sleep, iron deficiency and thyroid disease can all contribute, which is why the eye area is a place where a careful history matters more than a cream.
A systematic review of treatments for periorbital hyperpigmentation included 39 studies, covering options for volume loss, for lax skin and for pigment, and concluded that high-quality evidence is scarce and its recommendations should be read selectively. There are things dermatology can offer, chosen by which component is causing the darkness, and the evidence for each is uneven.
When to see a doctor
See a doctor or a dermatologist if:
- the darkness is on one side only, or has appeared suddenly;
- there is swelling, pain, itching, discharge or a gritty feeling in the eye;
- a mole or spot near the eye is changing in size, shape or colour, or is new;
- the skin of the whole face is darkening, not just the eye area;
- the circles come with fatigue, breathlessness, heavy periods or unusual pallor, which need a blood count rather than a cosmetic approach;
- there is ankle swelling, puffiness that is worse in the morning and settles through the day, or a change in urine output;
- the circles come with persistent nasal congestion, sneezing or itchy eyes;
- you have tried the self-care on this page for two to three months and nothing has changed.
Those are not reasons to abandon Chinese medicine. They are reasons to have the ordinary medical causes looked at first, because several of them are treatable and none of them is diagnosed from the appearance of the skin alone.
Safety
Safety
Anything applied to the skin around the eye is patch tested first, on the inner forearm, over 24 hours. The eye area is thin, close to the eye itself, and reacts to products faster than the cheek does.
Nothing here is pressed, rubbed or massaged into the eyeball. Work on the orbital bone, with the pad of a finger, and stop short of the lid margin.
Hegu (LI-4), Sanyinjiao (SP-6), Jianjing (GB-21) and Kunlun (BL-60) are classically avoided in pregnancy, and any page that uses them says so. Herbs that move Blood, including San Qi, Hong Hua and Tao Ren, are avoided in pregnancy and by anyone on anticoagulant medication unless a practitioner has reviewed it.
Do not massage over a mole or a lesion. Do not use a strong or scented oil close to the eye. If a product stings, rinse it out with water and stop using it.
This page does not diagnose anything, and a Chinese medicine reading of dark circles does not exclude a medical cause. If anything in the list on the previous section applies to you, see a doctor.
Evidence
No verified human study of a TCM intervention for the condition on this page. Editorial policy
Traditional use. No verified human study of any Chinese medicine treatment for dark circles was found when this page was planned, so the patterns above are recorded as tradition and nothing more.
These are the human studies we found on PubMed (searched October 2026), and all of them concern the conventional view rather than this approach. A systematic review of periorbital hyperpigmentation treatments included 39 studies across several treatment categories and concluded that high-quality evidence is scarce. Two reviews set out how the appearance is evaluated and why the causes must be separated first. One study of sleep quality and skin ageing also assessed under-eye circles, described on sleep-stress-skin; it is a study of sleep, not of treatment.
The bibliography for the conventional half of this page is on the conventional view page's sources, listed below.
Common questions
What causes dark circles under the eyes in Chinese medicine?
They are read as a sign rather than a cause. The four patterns most often described are Kidney and Liver Yin deficiency, Blood stagnation, Spleen and Stomach Qi deficiency, and Kidney Yang deficiency with water overflowing. Which one fits depends on the whole picture, not on the colour alone, which is why a practitioner asks about onset, timing and the signs that accompany it.
Are dark circles a sign of kidney deficiency?
Sometimes, and that answer is less useful than it sounds. Two of the four patterns involve the Kidney, but they are different pictures with different treatments, and one of them is about fluid rather than about depletion. Dark circles have many causes, including ones that have nothing to do with Chinese medicine patterns, and several of those need a medical check.
Can acupressure or gua sha help dark circles?
They are traditionally used, and neither has been tested for this in a human study. Gentle pressure on the orbital points and light gua sha on calm skin are low risk for most people, provided nothing is pressed into the eye and the exclusions on those pages are respected. Anyone expecting a change within a week should be told plainly that no study supports that.
Which herbs are used for dark circles in TCM?
The choice follows the pattern. Gou Qi Zi and Nu Zhen Zi are used in the depletion picture, Dang Gui and San Qi in the stagnation picture, Bai Zhu and Fu Ling in the Spleen picture. These are taken internally in formulas by a practitioner, not applied to the skin, and the Blood-moving herbs carry real cautions for pregnancy and for anyone on anticoagulants.
Do dark circles go away with treatment?
Sometimes they change, and the honest answer is that nobody can promise which way. The structural component, which is about volume and shadow, does not respond to herbs or to acupressure. The vascular component often tracks sleep and allergy. The pigmentary component belongs on the pigmentation pages of this compendium. A practitioner will usually say what they are treating and over what period.
When should dark circles be checked by a doctor?
When they are one-sided, sudden or painful, when they come with swelling, discharge or eye symptoms, when a mole nearby is changing, when the whole face is darkening, or when they come with fatigue, breathlessness, ankle swelling or changes in urine output. Those point to causes that need investigating rather than a cosmetic routine.
Sources
Clinical studies
- Michelle L, Pouldar Foulad D, Ekelem C, et al. 2021. Treatments of Periorbital Hyperpigmentation: A Systematic Review.. Dermatologic Surgery. PMID: 32740208. Systematic review; 39 studies; limits: Authors state that high-quality evidence is scarce and recommendations should be interpreted selectively
- Vrcek I, Ozgur O, Nakra T. 2016. Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment.. Journal of Cutaneous and Aesthetic Surgery. PMID: 27398005. Narrative review; not applicable; limits: Review, not a study
- Liew S, Doreian S, Kunathathorn W, et al. 2024. Lower Eyelid Dark Circles (Tear Trough and Lid-Cheek Junction): A Stepwise Assessment Framework.. Aesthetic Surgery Journal. PMID: 38489829. Clinical assessment framework; not applicable; limits: Framework for assessment, not a test of treatment
- Oyetakin-White P, Suggs A, Koo B, et al. 2015. Does poor sleep quality affect skin ageing?. Clinical and Experimental Dermatology. PMID: 25266053. Cross-sectional comparison of good and poor sleepers, including standardised photographs of under-eye circles; 60 women; limits: Associational; self-reported sleep quality; not a study of any treatment